With help from Joanne Kenen, David Nather, Brett Norman and Kathryn Smith

A HEALTH CARE GUIDE TO THE DEBT LIMIT FIGHT — Here we go again. This week’s fiscal cliff deal cut about $30 billion from the health care industry — mostly to pay for the one-year “doc fix” — but that could be just the tip of the iceberg if Republicans can win major cuts in return for raising the debt ceiling. Doctors are worried about possible cuts to new Medicaid bonus payments and medical training programs. Hospitals, which took a $14 billion hit in the fiscal cliff deal, will make the case that they’ve already been pushed to the limit on cuts they can tolerate without hurting patient care. Other major industry players are all on guard for possible cuts, too. The POLITICO Pro guide: http://politico.pro/RvjRoN

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Happy Friday and welcome to PULSE. It’s officially the quiet before the debt limit storm. Enjoy it while you can, people.

“I wanna see your PULSE from the stands, come on, come on”

TODAY ON POLITICO PRO:

--FISCAL CLIFF LEAVES WOULD-BE CO-OPS HOLDING THE BAG — Most of the Affordable Care Act emerged from the fiscal cliff deal unscathed, but not the federally backed nonprofit health plans that were meant to compete with the commercial insurers that dominate most markets. http://politico.pro/Rvj33d

--UTAH EXCHANGE SURPRISE — ACA supporters and critics have long expressed serious doubts that Utah’s exchange would ever pass HHS’s sniff test, but it cleared an important first hurdle yesterday. http://politico.pro/W7A2Fb

HEALTH INSURERS WANT CUSTOMERS — FAST — AHIP is trying to give HHS a sense of urgency about getting lots of people into the health insurance pools really quickly, now that they’re about to start covering everyone with pre-existing conditions. In a comment letter to HHS on the proposed health insurance market rules, AHIP suggests that the department could try imposing late enrollment fees on its own — a strategy that had been widely suggested as an alternative to the individual mandate if it ever got struck down. The trade group also says there are other methods, such as limiting the coverage options for late enrollees or allowing waiting periods before their coverage kicks in. Those are the kinds of strategies that might be needed to keep people from waiting until the last minute to sign up, AHIP says, especially since they won’t face the full individual mandate penalties if they don’t enroll in 2014 or 2015. The comment letter: http://politico.pro/Wh5T6z

HHS: NO EXCHANGE CERTIFICATION DEADLINE — As of yesterday, 19 states and Washington, D.C., have received conditional approval from HHS to run their own exchanges. That means they all still have some work to do to get ready before open enrollment starts Oct. 1. But HHS insists that there isn’t a deadline for final exchange certification — when HHS would have to declare a state fully ready to operate its own exchange, or when HHS would say it has to step in to run some exchange functions. “We continue to work with the states,” said CCIIO Director Gary Cohen on a conference call yesterday. “Each state is in a different stage, so we don’t feel that we need to have a deadline today, but the commitment is that they’ll either operate a state-based exchange or we’ll have a federally facilitated exchange in each state.”

NO IMMEDIATE ACTION FROM UTAH GOV — A senior aide for Gov. Gary Herbert told the Salt Lake Tribune that Herbert is reviewing HHS conditional approval but isn’t committing to anything yet. “Utah’s position on our state health exchange has not changed, and it will not change,” Herbert deputy chief of staff Ally Isom told the paper. “Because it’s consumer-driven, market-based and flexible, Utah’s model is the right solution for Utah.” The Tribune story: http://bit.ly/136Hu9T

— Utah keeps saying publicly that it wants to keep its model in place, but Herbert’s administration has actually proposed a lot of changes to its exchange, known as Avenue H. Check out Utah’s 73-page exchange blueprint: http://politico.pro/131EUml

MISSISSIPPI GOVERNOR TRIES TO BLOCK EXCHANGE — HHS said yesterday it hit pause on Mississippi Insurance Commissioner Mike Chaney’s exchange blueprint application because of a dispute among state officials, and The Associated Press has the latest details in the ongoing battle between the Republican insurance commissioner and GOP Gov. Phil Bryant. In an 11th-hour effort to block Chaney’s exchange blueprint, Bryant wrote a Dec. 28 letter to HHS arguing that only he can authorize an exchange. Bryant had previously written a couple of letters to HHS expressing his opposition to a state-run exchange, but this appears to be the first time he’s disputing Chaney’s power to unilaterally create an exchange. HHS officials yesterday said they’re going to let Mississippi officials sort things out before deciding on Chaney’s blueprint. The AP story: http://hatne.ws/WoBVxQ

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WHERE’S THE PHYSICIAN SUNSHINE RULE ALREADY? The National Physicians Alliance and the American Medical Student Association want to know what exactly happened to a regulation that is 15 months overdue in implementing the Physician Payment Sunshine Act. They join a growing chorus from Congress, industry and trade associations urging the Obama administration to release the rule that will govern how pharmaceutical and medical device companies have to disclose payments to doctors. The letter: http://politico.pro/S7kuGo

OBAMA SIGNS CANCER RESEARCH MEASURE — While we were focused on the cliff, President Barack Obama also this week signed the Recalcitrant Cancer Research Act into law. The legislation, attached to the defense authorization, directs the National Cancer Institute to improve early detection methods and find better treatment options for the deadliest forms of cancer, such as pancreatic and lung. Julie Fleshman, president and CEO of the Pancreatic Cancer Action Network, called it “a historic victory” in the fight against the nasty diseases.

FAMILIAR NAMES TO LAUNCH STATE HEALTH GROUP — Some health care and state policy heavyweights are announcing today the launch of the State Health Care Cost Containment Commission to examine ways to cut health costs while improving the quality of care. Former National Governors Association executive director Raymond Scheppach will helm the project, which is co-chaired by former HHS Secretary Mike Leavitt and former Colorado Gov. Bill Ritter. One of the reasons they’re putting the commission together: They don’t have a lot of confidence the partisan rancor in Washington will produce major cost containment efforts at the federal level, so they say it’s up to the states to take the lead in the next few years.

ONE MORE CONTRACEPTION RULE INJUNCTION — Another private company got a preliminary injunction yesterday against the Obama administration’s contraceptive coverage policy. The District Court of the Northern District of Illinois awarded the injunction to Triune Health Group, which helps injured workers re-enter the workforce. The order: http://politico.pro/UiqxZH

FOX DOC FOR SENATE? — Dr. Keith Ablow, a psychiatrist who is a Fox News contributor, has diagnosed the country as dysfunctional and says the remedy might be … him. Eyeing the race to succeed John Kerry, Ablow said in a statement, “The dysfunction in Washington and the tragedy in Newtown, Conn., are both signs this country needs help and, if neither William Weld nor Scott Brown is the candidate to bring that help from Massachusetts to Washington, I will take those who have asked me to run much more seriously.” Ablow is the guy who speculated on air that Vice President Joe Biden’s frequent interruptions of Rep. Paul Ryan during their debate and his “inappropriate” laughter might be a symptom of dementia. His statement: http://prn.to/Xozv8K. His Biden remarks: http://bit.ly/Rzy8Qd

ICYMI: HOSPICES FIGHT LOUISIANA CUTS — The Louisiana-Mississippi Hospice and Palliative Care Association is objecting to Gov. Bobby Jindal’s decision to cut Medicaid coverage of hospice starting Feb. 1. “While the [organization’s] board strongly disagrees with this decision, the board is even more confused by the administration’s assertion that this action will save the state $10.6 million in FY2014,” it said in a statement around the holidays. Without hospice, many dying people will end up in more expensive hospital settings, the group said. When Arizona cut Medicaid hospice in 2009, it ended up restoring the benefit a year later because the move had actually increased costs. The statement: http://politico.pro/XoEVAB

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About The Author

Jason Millman is POLITICO Pro’s Deputy Health care reporter. He’s on his second tour of duty at POLITICO after a stint at the Washington Post’s Wonkblog and has covered health care since graduating from Boston University with a journalism degree in 2008.